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The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-05-17T21:04:44Z No. of bitstreams: 1 Marco Antonio Costantino Valentini.pdf: 7198882 bytes, checksum: bd8c05f9cc33b87e6a7723bf00ea1d81 (MD5) Made available in DSpace on 2021-05-17T21:04:44Z (GMT). No. of bitstreams: 1 Marco Antonio Costantino Valentini.pdf: 7198882 bytes, checksum: bd8c05f9cc33b87e6a7723bf00ea1d81 (MD5) Previous issue date: 2021-02-25 The literature demonstrates the importance of Risk Management in projects, as well as the difficulty of project managers in identifying risks. Some existing techniques and tools prove to be very laborious or ineffective for the adequate treatment of risks in projects, so that the identification of these risks is undersized, with negative impacts on their results and objectives. This research aims to facilitate the identification of risks in information technology (IT) projects through the use of a tool, a chatbot, in which project managers can inform the characteristics of their projects, to obtain a list of most likely risks to the analysis processes. As a research method, Design Science Research was applied in four phases. In the first phase, the problem was identified through a survey of 158 managers and project team members, aiming to identify the difficulties that are encountered in the identification of risks, generating a list. Phase 2, defining the objectives of a solution, was used a focus group with ten experienced IT project managers, aiming to obtain a satisfactory solution, aiming to confirm and expand the findings of the initial survey. In the next phase, of design and development, a base with 1,725 risks was synthesized in 1540 and the chatbot (prototype) was developed. In the demonstration and evaluation phase, the chatbot was used to solve an instance of the problem, presenting it to the confirmatory focus group and it was observed how well the chatbot supports the solution of the problem, comparing the objectives of the developed solution with the results obtained in the demonstration phase. As a result, it was found that the artifact reached met the objectives of utility, ease of use, effectiveness and operational viability. The practical contribution of this research is to facilitate the identification of risks at any time during project management, especially in the initiation phase and, as early as possible, to plan the most appropriate responses and actions. A literatura demonstra a importância da Gestão de Riscos em projetos, bem como a dificuldade dos gerentes de projeto na identificação de riscos. Algumas técnicas e ferramentas existentes se mostram muito trabalhosas ou pouco eficazes para o tratamento adequado dos riscos em projetos, de maneira que a identificação desses riscos é subdimensionada, com impactos negativos em seus resultados e objetivos. Esta pesquisa tem como objetivo facilitar a identificação de riscos nos projetos de tecnologia da informação (TI) por meio da utilização de uma ferramenta, um chatbot, no qual os gerentes de projeto possam informar as características dos seus projetos, para obtenção de uma lista de riscos mais prováveis para os processos de análise. Como método de pesquisa, foi aplicado o Design Science Research em quatro fases. Na primeira fase, foi identificado o problema, por meio de uma survey com 158 gestores e membros de equipe de projetos, visando identificar as dificuldades que são encontradas na identificação de riscos, gerando uma lista. A fase 2, definir os objetivos de uma solução, foi utilizado um grupo focal com dez gestores de projetos de TI experientes, visando a obtenção de uma solução satisfatória, visando confirmar e expandir os achados do levantamento inicial. Na fase seguinte, de design e desenvolvimento, uma base com 1.725 riscos foi sintetizada em 1540 e foi desenvolvido o chatbot (protótipo). Na fase de demonstração e de avaliação, usou-se o chatbot para resolver uma instância do problema, apresentando-o ao grupo focal confirmatório e observou-se quão bem o chatbot suporta a solução do problema, comparando os objetivos da solução desenvolvida com os resultados reais obtidos na fase de demonstração. Como resultado, verificou-se que o artefato atendeu aos objetivos de utilidade, facilidade de uso, efetividade e viabilidade operacional. A contribuição prática desta pesquisa está em facilitar a identificação de riscos em qualquer momento da gestão de projetos, principalmente na fase de iniciação e assim, com a maior antecedência possível, planejar as respostas e ações mais adequadas.

For some years now, the idea of a fully autonomous driving car has been monopolizing the attention of the entire automotive sector. The main motivation behind all this interest is that autonomous driving cars could potentially improve road safety simply by subtracting human error, which causes thousands of road fatalities worldwide every year. One of the biggest challenges, for which researchers are working hard to give answers, concerns the search of solutions to improve the people’s response to this vehicles once they are put on the road: an incorrect answer can lead to their unsuccess, with a great monetary loss for all the companies that have invested in these technologies. Recently, we worked on a project that went in this direction and which regarded the possibility to change the driving style of the autonomous driving cars based on the passengers’ facial expressions. This is particularly useful in the event that they experience fear: the car may react to these feelings by adopting a careful driving style and stopping if these feelings do not improve within a certain period. In this paper, we want to discuss about the improvements we have made to this project.

The development of autonomous driving cars is a complex activity, which poses challenges about ethics, safety, cybersecurity, and social acceptance. The latter, in particular, poses new problems since passengers are used to manually driven vehicles, hence, they need to move their trust from a person to a computer. To smooth the transition towards autonomous vehicles, a delicate calibration of the driving functions should be performed, making the automation decision closest to the passengers&rsquo, expectations. The complexity of this calibration lies in the presence of a person in the loop: different settings of a given algorithm should be evaluated by assessing the human reaction to the vehicle decisions. With this work, we for an objective method to classify the people&rsquo, s reaction to vehicle decisions. By adopting machine learning techniques, it is possible to analyze the passengers&rsquo, emotions while driving with alternative vehicle calibrations. Through the analysis of these emotions, it is possible to obtain an objective metric about the comfort feeling of the passengers. As a result, we developed a proof-of-concept implementation of a simple, yet effective, emotions recognition system. It can be deployed either into real vehicles or simulators, during the driving functions calibration.

Liver tumors, excluding hepatocellular carcinoma and metastatic disease, are rare. However, it is important to understand how to distinguish these lesions from hepatocellular carcinoma. They run the spectrum of benign to malignant, some aggressive with relatively few therapeutic options. The goal of this paper is to review the most recent literature to provide current insights into diagnosis, treatment, and pathogenesis of these tumor types. Recent literature has focused on oncogenomics and putative targets for therapeutic intervention. Several ongoing studies are elucidating molecular pathways and evaluating novel therapies in these rare tumors and we focus on these findings, particularly in intrahepatic cholangiocarcinoma and fibrolamellar HCC. While these advances are promising, surgical resection continues to be associated with the greatest survival benefit for rare malignant tumors of the liver. Clinicians must be aware of rare liver tumors to distinguish them from hepatocellular carcinoma and to develop a differential diagnosis in complicated or atypical presentations. In these rare tumors, advances in understanding tumor biology hold the promise of expanding diagnostic and therapeutic possibilities.

INTRODUCTION: During the COVID-19 pandemic, differentiating between acute infectious diarrhea versus a chronic inflammatory bowel disease (IBD) presents a new challenge altering the way we approach the diagnosis and treatment of IBD CASE DESCRIPTION/METHODS: A 20-year-old gentleman with no known past medical history presented to his PCP with 14 bloody bowel movements daily He was started on a 5-day course of Azithromycin Stool studies were sent and his C Difficile stool antigen turned positive He was switched to oral Vancomycin He presented to the hospital 3 days later after no improvement On presentation, patient was febrile with diffuse abdominal and rectal pain Initial lab results revealed leukocytosis (29 5K) with elevated bands (35), CRP 127 3, Albumin 3 0, Ferritin 236, Procalcitonin 1 13, Fibrinogen 698, and D-Dimer 1 57 Repeat stool studies were negative His SARS CoV-2 PCR was positive Chest X-ray was unremarkable CT abdomen revealed diffuse colonic wall thickening and peri-colonic inflammation consistent with pancolitis without intra-abdominal or pelvic abscess Symptoms improved with antibiotics Flexible sigmoidoscopy revealed diffuse, severely edematous and erythematous mucosa with granularity and discontinuous areas of ulcers of varying size and depth seen in descending colon Ulcerations were superficial and circumferential Due to severity of disease and contact bleeding, scope was not advanced beyond this point The lumen became narrowed due to inflammation without overt stricture or obstructing lesions The sigmoid colon and rectum, ulcerations became mixed with exudates and the area was generally less effected Numerous biopsies were taken Pathology showed severe chronic active colitis with ulceration Histology showed frequent crypt abscesses, cystic crypt changes and basal lympho-plasmacytosis There is no definite Paneth cell metaplasia, pseudomembranous or viral cytopathic changes After multidisciplinary discussion, he was started on IV Solumedrol 72 hours later patient reported near resolution in symptoms and was transitioned to oral Prednisone taper He was started on Infliximab 10 mg/kg prior to discharge after a repeat COVID test was negative Outpatient follow up was arranged for repeat testing and interval colonoscopy DISCUSSION: The documentation of collective experiences with newly diagnosed IBD patients during the COVID pandemic presents a diagnostic and therapeutic dilemma possibly altering our decisions moving into a new era

Spontaneous intraperitoneal hemorrhage (SIPH), or abdominal apoplexy, is a rare complication of protracted vomiting. Although usually seen later in life, increased alcohol consumption may be contributory to the accelerated incidence of SIPH among younger populations. We describe a 22-year-old male who presented with abdominal pain after prolonged retching in the setting of binge drinking. A CT scan identified a highly attenuated intraperitoneal collection measuring 7.6 cm x 11.6 cm x 15.9 cm adjacent to the stomach. Due to hemodynamic instability, exploratory laparotomy was emergently performed and 1600 mL of blood was evacuated. A diagnosis of SIPH was made with bleeding visualized from a short gastric artery. Ultimately, vessel ligation failed to achieve hemostasis at the splenic hilum and a splenectomy was required. Given that a delay in identification may prove fatal, this case highlights the importance of recognizing SIPH as a differential diagnosis for unexplained abdominal pain and shock after persistent vomiting.

Intussusception is commonly seen in children but is rare in adults and represents only 5% of all intussusceptions causing 1% of intestinal obstructions. More than 50% of these intussusceptions in adults are due to intestinal neoplasms, including malignant lymphoma, e.g., Burkitt lymphoma. These lymphomas are more common in human immunodeficiency virus (HIV)-positive patients than in the general population. We present a case of a young male who was diagnosed with HIV when he developed intestinal obstruction and intussusception secondary to Burkitt lymphoma. He was managed with surgical resection followed by chemotherapy and antiretroviral treatment. HIV patients presenting with acute abdomen pose a diagnostic challenge to clinicians due to a wide range of differential diagnoses including inflammatory, infectious and neoplastic conditions. In a young HIV patient presenting with acute abdomen, intussusception caused by Burkitt lymphoma should be considered in the differential.

Soils have a great potential in stocking soil organic carbon SOC, but how much can human activities, and particularly agricultural ones, contribute to increase (or decrease) the SOC content? Which kind of agricultural practices are the most effective? From the soil database of Sicily we have selected 52 profiles, whose first 40 cm from the soil surface were analyzed for the SOC, of which 15 analyzed also for nitrogen N content, localized in the clayey hills and limestone marine terraces of the western Sicily, cultivated with grain crops and orchards (mainly olive groves and vineyards), surveyed and analyzed in a period from 1995 to 2008. By interviews to the farmers owners of those parcels, we collected informations about the agricultural practices (tillage, fertilization, rotations, associations and soil protection measures) adopted in the period of the survey, for each of the 52 fields. The adoption of any of the agri-environmental measures promoted by the Region of Sicily was also verified. In the same study area we collected, in 2013 and 2014, samples of the first 40 cm from the soil surface, of 22 parcels cultivated with grain crops, and performed the interviews to the farmers to check the agricultural practices adopted. The samples where analyzed for SOC and N, and also for the humic and fulvic SOC fractions. An analysis of variance was performed. The results demonstrated that reduced tillage practices were the most effective in stocking SOC in soils, especially if associated with other biological farming practices promoted by the regional agri-environmental measures. In fact the SOC and C/N ratio were significantly higher with reduced tillage, associated with biological farming. Instead the SOC, and its humic and fulvic fractions, did not result significantly different comparing biological versus chemical fertilization practices alone. The N content was significantly higher with chemical fertilization.

In this paper a preliminary tridimensional CFD analysis is carried out for a future realization of a reduced-scale road tunnel experimental apparatus of 1/50 equipped with different impulsive fans, traditional and alternative. The alternative jet fan is provided of inlet/outlet sections inclined at a fixed pitch angle (α=6°) toward the tunnel floor. Typically, in the experimental scale tunnel model the air flow induced by ventilation system is provided by an external fan and fully developed flow field is considered. In this paper, the authors have simulated a realistic full and reduced-scale tunnel in order to evaluate the influence of ceiling and floor roughness height on the velocity field to identify an appropriate material for a future experimental apparatus. The jet fans are simulated as a simple momentum source. The fan is considered to be infinitely thin and the discontinuous pressure rise (pressure drop) across it is defined as a function of the air velocity through the fan. In order to create a reduced-scale model from a full scale, Froude method is applied to preserve geometrical, kinematical and dynamical similitude. The results, provided in terms of axial velocity profiles in different tunnel sections, show the overlapping between velocity profiles of full scale numerical model with those of the reduced-scale model, for the both ventilation systems.

An automatic manufacturing system design must be optimized with a simulation including all the interacting devices. The simulation should be controlled by the real control system with a hardware in the loop approach. So the techniques for modeling the mechanisms must be effective for the model to be run without violating the real-time protocol. This paper reports a method to model the motor load by means of a reduced moment of inertia, where all the part downstream from the motor output shaft is transformed in function of the only one mechanism degree of freedom. The resulting model behaves as the real nonlinear mechanism, but it is computationally efficient since it is not ruled by the multibody 3D CAD mathematics.